Infant Sleep Research Articles

Sensory Processing & Sleep in Infants & Toddlers in a Medically Underserved Area: A Cohort Study

Abstract Date Presented 04/22/2023 Low registration was stable over time, but sensory avoidance was not. Low registration is typically not a category in which a child will be physically active to self-regulate as a part of the profile. Primary Author and Speaker: Bryan M. Gee Contributing Authors: Nicki L. Aubuchon-Endsley

Prenatal depressive symptoms are associated with altered structural brain networks in infants and moderated by infant sleep

BackgroundThe prevalence of prenatal depressive symptoms has more than doubled during the COVID-19 pandemic, raising substantial concerns about child outcomes including sleep problems and altered brain development. The objective of this work was to determine relationships between prenatal depressive symptoms, infant brain network structure, and infant sleep. MethodsPregnant individuals were recruited as part of the Pregnancy during the Pandemic (PdP) study. Maternal depressive symptoms were measured in pregnancy and postpartum. When infants of those participants were 3 months of age (n=66; 26 females), infants underwent diffusion magnetic resonance imaging and infant sleep was evaluated. Using tractography, we calculated structural connectivity matrices for the default mode (DMN) and limbic networks. We examined associations between graph theory metrics of infant brain networks and prenatal maternal depressive symptoms, with infant sleep as a moderator. ResultsPrenatal depressive symptoms were negatively related to average DMN clustering coefficient and local efficiency in infant brains. Infant sleep duration was related to DMN global efficiency and moderated the relationship between prenatal depressive symptoms and density of limbic connections such that infants who slept less had a more negative relationship between prenatal depressive symptoms and local brain connectivity. ConclusionsPrenatal depressive symptoms appear to impact early topological development in brain networks important for emotion regulation. In the limbic network, sleep duration moderated this relationship, suggesting sleep may play a role in infant brain network development.

Fetal SSRI antidepressant exposure and infant sleep: Findings from the MPEWS pregnancy cohort study

This longitudinal study examines the association between fetal Selective Serotonergic Reuptake Inhibitor antidepressant exposure and infant sleep behaviours at six and 12 months of age and focus on three of the most commonly prescribed antidepressants in pregnancy.This study utilises data on 698 women recruited at less than 20 weeks of pregnancy and are followed up at six and 12 months postpartum. Women were recruited into one of three groups: those taking either sertraline, citalopram or escitalopram antidepressants in pregnancy (n = 85); women with a depressive disorder who were not taking antidepressants (non-medicated depressed, NMD; n = 82); and, and a control group of women (n = 531). At six and 12 months, data were collected on breastfeeding and sleep location and infant sleep was measured using the Brief Infant Sleep Questionnaire. Antidepressants sertraline, escitalopram and citalopram were not associated with increased infant waking or time awake. However, sertraline was associated with longer time for an infant to go to sleep.This study provides reassurance that SSRI antidepressants and, in particular, sertraline, escitalopram and citalopram are not associated with infant sleep behaviours that are commonly regarded as problematic including night waking. Further replication of these findings, including with direct measures of infant sleep, are recommended.

Prenatal exposure to per- and polyfluoroalkyl substances and infant sleep disturbance: A prospective cohort study

BackgroundPrenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect fetal brain development, yet no study has investigated the potential association between prenatal PFAS exposure and infant sleep. ObjectivesTo explore the associations of prenatal PFAS exposure with infant sleep disturbances during the first year of life in a prospective cohort study. MethodsWe recruited 4127 pregnant women from the Shanghai Birth Cohort (SBC) and followed their children from birth to 12 months old. A total of 2366 infants were included in the 6-month analyses, and 2466 infants in the 12-month analyses. Ten PFAS were quantified in blood serum collected in the first trimester. Sleep quality was measured using the Brief Infant Sleep Questionnaire. We used multiple linear regression and multinomial logistic regression to estimate the individual effects of PFAS on sleep outcomes. We utilized a quantile-based g-computation model to determine the joint effects of the PFAS mixture on infant sleep outcomes. Additionally, generalized estimating equation (GEE) models were performed to examine the longitudinal effects of PFAS exposure during pregnancy. ResultsIn infants aged 6 months, perfluorooctane sulfonate and perfluoroheptanoic acid were associated with a more than 2-fold risk of parent-reported sleep problems as severe. Perfluorodecanoic acid was associated with an increased risk of often or almost always snoring in one-year-old infants (relative risk ratios, 1.79; 95% CI, 1.12–2.86). PFAS mixtures were positively associated with nighttime awakenings both among infants aged 6 months (β, 0.11; 95% CI, 0.04–0.19) and 12 months (β, 0.11; 95% CI, 0.05–0.18). Prenatal exposure to PFAS were associated with longer sleep latency, increased nighttime awakenings, longer nocturnal wakefulness hours, snoring, and earlier sleep-onset time in infants aged 6–12 months, according to GEE models. ConclusionsOur study suggests that prenatal exposure to PFAS may increase the risk of sleep disturbance in infants.

The impact of extreme summer temperatures in the United Kingdom on infant sleep: Implications for learning and development

The U.S. Global Change Research Program reports that the frequency and intensity of extreme heat are increasing globally. Studies of the impact of climate change on child health often exclude sleep, despite its importance for healthy growth and development. To address this gap in the literature, we studied the impact of unusually high temperatures in the summer of 2022 on infants’ sleep. Sleep was assessed objectively using Nanit camera monitors in infants’ homes. Generally, sleep was not impacted when temperatures stayed below 88° but was negatively impacted when temperatures reached over 100°. Compared to non-heatwave nights, infants had less total sleep, less efficient sleep, took longer to fall asleep, had more fragmented sleep, and parents’ visits were more frequent during the night. Following peaks in temperature, sleep metrics rebounded to better than average compared to non-peak nights, suggesting that infants compensated for disrupted sleep by sleeping more and with fewer interruptions once the temperature dropped below 85°. Increased instances of disrupted sleep in infancy have important implications for psychological health and development. Climate disruptions such as heat waves that create occasional or ongoing sleep disruptions can leave infants vulnerable and unprepared for learning.

Sleep quality and temperament in association with autism spectrum disorder among infants in Japan

BackgroundSleep problems and irritable temperaments are common among infants with autism spectrum disorder (ASD). The prospective association between such sleep problems and irritable temperaments and ASDs needs to be determined for elucidating the mechanism and exploring the future intervention study. Thus, in this study, we investigated whether sleep quality and temperament in 1-month-old infants are associated with the onset of ASD in 3-year-old children. We also assessed its sex-stratified associations.MethodsWe conducted a longitudinal study using data from 69,751 mothers and infants from a large-cohort study, the Japan Environment and Children’s Study. We examined the prospective association between infant sleep quality and temperament at 1 month of age and ASD diagnosis by 3 years of age.ResultsHere we show infants with longer daytime sleep have a higher risk of later ASD than those with shorter daytime sleep (risk ratio [RR]: 1.33, 95% confidence interval [CI]: 1.01–1.75). Infants who experienced intense crying have a higher risk of ASD than those who did not (RR: 1.31, 95% CI: 1.00–1.72). There is a difference in sex in the association between a bad mood and later ASD. In particular, female infants experiencing bad moods have a higher risk of ASD than others (RR: 3.59, 95% CI: 1.91–6.75).ConclusionsThe study findings provide important information for future intervention to reduce the risk of future ASD.

Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey.

To assess infant breastfeeding initiation and any breastfeeding at 8 weeks and safe sleep practices (back sleep position, approved sleep surface, and no soft objects or loose bedding ["soft bedding"]) by select paternal characteristics among a state-representative sample of fathers with new infants. Pregnancy Risk Assessment Monitoring System (PRAMS) for Dads, a novel population-based cross-sectional study, surveyed fathers in Georgia 2-6 months after their infant's birth. Fathers were eligible if the infant's mother was sampled for maternal PRAMS from October 2018 to July 2019. Of 250 respondents, 86.1% reported their infants ever breastfed and 63.4% reported breastfeeding at 8 weeks. Initiation and breastfeeding at 8 weeks were more likely to be reported by fathers who reported wanting their infant's mother to breastfeed than those who did not want her to breastfeed or had no opinion (adjusted prevalence ratio [aPR] = 1.39; 95% confidence interval [CI], 1.15-1.68; aPR = 2.33; 95% CI, 1.59-3.42, respectively) and fathers who were college graduates than those with ≤high school diploma (aPR = 1.25; 95% CI, 1.06-1.46; aPR = 1.44; 95% CI, 1.08-1.91, respectively). Although about four-fifths (81.1%) of fathers reported usually placing their infants to sleep on their back, fewer fathers report avoiding soft bedding (44.1%) or using an approved sleep surface (31.9%). Non-Hispanic Black fathers were less likely to report back sleep position (aPR = 0.70; 95% CI, 0.54-0.90) and no soft bedding (aPR = 0.52; 95% CI, 0.30-0.89) than non-Hispanic white fathers. Fathers reported suboptimal infant breastfeeding rates and safe sleep practices overall and by paternal characteristics, suggesting opportunities to include fathers in promotion of breastfeeding and infant safe sleep.

Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. Local problemA multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. MethodsA comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. InterventionsInterventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. ResultsDocumented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. ConclusionsA multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

A Hospital-Based Infant Safe Sleep Intervention and Safe Sleep Practices Among Young Women: A Prospective Longitudinal Study.

The rates of sudden unexpected infant death (SUID) are still high in the U.S. The longitudinal effects of SUID preventive education on infant safe sleep practices are less known. The current study evaluated the effects of a comprehensive hospital-based, SUID preventive intervention on safe infant sleep practices in the first six months of life and to identify factors associated with infant sleep practices. Using a one-group pretest and multiple posttest design, the current quantitative study examined the impacts of the infant safe sleep intervention among 411 women recruited at a large, urban, university medical center. Participants were prospectively followed and completed four surveys from childbirth. Linear mixed models were used to evaluate the effects of the SUID prevention program on four sleep practice outcomes, including removing unsafe items from the sleeping environment, bed sharing, room sharing without bed sharing, and placing the infant in a supine sleep position. Compared to the baseline, participants were less likely to use unsafe items (e.g., soft bedding) in infants' sleeping areas over time. However, we found that participants reported more frequent bed sharing at 3-month and 6-month follow-ups, compared to the baseline. Overall, maternal education and family income were positively related to healthy infant safe sleep practices. A hospital-based preventive intervention pairing an educational initiative with home-visiting services might improve safe sleep practices to remove accidental suffocation risks from the infant sleep environment.

A longitudinal study of infant 24-hour sleep: comparisons of sleep diary and accelerometer with different algorithms.

To longitudinally compare sleep/wake identification and sleep parameter estimation from sleep diaries to accelerometers using different algorithms and epoch lengths in infants. Mothers and other caregivers from the Nurture study (southeastern United States, 2013-2018) reported infants' 24-hour sleep in sleep diaries for 4 continuous days, while infants concurrently wore accelerometers on the left ankle at 3, 6, 9, and 12 months of age. We applied the Sadeh, Sadeh Infant, Cole, and Count-scaled algorithm to accelerometer data at 15 and 60 seconds epochs. For sleep/wake identification, we assessed agreement by calculating epoch-by-epoch percent agreement and kappas. We derived sleep parameters from sleep diaries and accelerometers separately and evaluated agreement using Bland-Altman plots. We estimated longitudinal trajectories of sleep parameters using marginal linear and Poisson regressions with generalized estimation equation estimation. Among the 477 infants, 66.2% were black and 49.5% were female. Agreement for sleep/wake identification varied by epoch length and algorithm. Relative to sleep diaries, we observed similar nighttime sleep offset, onset, and total nighttime sleep duration from accelerometers regardless of algorithm and epoch length. However, accelerometers consistently estimated about 1 less nap per day using the 15 seconds epoch, 70 and 50 minutes' shorter nap duration per day using the 15 and 60 seconds epoch, respectively; but accelerometers estimated over 3 times more wake after nighttime sleep onset (WASO) per night. Some consistent sleep parameter trajectories from 3 to 12 months from accelerometers and sleep diaries included fewer naps and WASOs, shorter total daytime sleep, longer total nighttime sleep, and higher nighttime sleep efficiency. Although there is no perfect measure of sleep in infancy, our findings suggest that a combination of accelerometer and diary may be needed to adequately measure infant sleep.

Penerapan Aroma Therapy Bunga (rose centifolia) dan Pijat Bayi Terhadap Durasi Tidur Bayi Usia 3-12 Bulan di RSUD Poso

Introduction: The impact of sleep disturbances in infants is that the baby becomes often awake and fussy. The importance of sleep time in infants, then the duration of sleep in infants must be completely fulfilled so as not to adversely affect their development. One of the nursing interventions to treat sleep disorders in infants is massage and rose aroma therapy. The purpose of this study was to describe the application of nursing care with massage interventions and rose aroma therapy to increase infant sleep duration. Method : Descriptive research methods with a case study approach. Results : the patient's mother said her child had a cough with phlegm, fever for 3 days, the patient was fussy and restless, the patient slept only ± 8 hours a day, the patient often woke up at night due to coughing, the patient was difficult to sleep well, the patient's face looked pale, often seen yawning, temperature: 38.9 ° C RR 46x / min, pulse 120x / min, there are additional ronchi breath sounds, nursing diagnosis of airway clearance, hyperthermia, sleep pattern disorders. Nursing interventions for airway management, warm compresses, massage therapy and aromatherapy. Implementation of chest physiotherapy measures as well as giving 1ml combiven nebulizer + 2ml Nacl and suctioning. Giving tepid water sponge, doing baby massage and giving rose aroma therapy. The results of the evaluation of the patient's sleep increased from 8 hours to 12 hours a day, the patient was calm, the patient woke up at night only asking for milk and after waking up the patient could fall asleep again, coughing with phlegm was reduced, vesicular breath sounds, temperature: 37°C, RR: 38x/min. Conclusion: giving baby massage and rose aroma therapy can increase the duration of infant sleep. nurses can provide baby massage combined with rose aroma therapy to increase the duration of infant sleep.

Drivers of decision-making regarding infant sleep practices among mothers with opioid use disorder.

To understand the perspectives and perceived facilitators of and barriers to following safe infant sleeping practices among mothers with opioid use disorder (OUD). Using the Theory of Planned Behavior (TPB) framework, we conducted qualitative interviews with mothers with OUD regarding infant sleep practices. We created codes and generated themes, concluding data collection upon achieving thematic saturation. Twenty-three mothers with infants 1-7 months of age were interviewed from 08/2020 to 10/2021. Mothers chose sleeping practices they perceived made their infants safer, more comfortable, and minimized infant withdrawal symptoms. Mothers in residential treatment facilities were influenced by facility infant sleep rules. Hospital sleep modeling and varied advice by providers, friends and family influenced maternal decisions. Mothers reported factors unique to their experience with OUD that influenced their decisions about infant sleep that should be considered when developing tailored interventions to promote safe infant sleep in this population.

The Relationship Between Maternal and Infant Sleep Duration Across the First Two Years.

The first objective of this study was to determine how mother-infant sleep duration is related across the first 2 years of life. The second objective was to determine whether these relationships change across the first 2 years of life. The third objective was to understand demographic and health predictors of the relationship between maternal and child sleep. Parents of 464 infants from the STRONG Kids 2 study reported their own and infants' nocturnal sleep duration and other health information (i.e., breastfeeding) at 3, 12, 18, and 24 months postpartum. Latent transition models revealed 2 mother-infant sleep profiles exist at 3 to 24 months. The low maternal sleep ( LMS ) pattern was characterized by lower maternal sleep duration than the recommended amount and lower infant sleep duration. The average maternal sleep ( AMS ) pattern was characterized by average maternal sleep duration meeting the recommended standard and average infant sleep duration. Approximately half of the mothers who started in the LMS profile transitioned to the AMS profile after 12 months postpartum. The sleep profiles stabilized after 12 months postpartum with limited transitions across 12 to 24 months. More infant-signaled nighttime wakings, later bedtimes, more infant sleep problems, and more exclusive breastfeeding were predictors of being in the LMS profile. Mother-infant sleep profiles stabilized after age 12 months, and mother-infant sleep profiles are driven by infant sleep quality during the night. The findings suggest the need to establish a healthy sleep routine for mothers and infants in the first year of life to promote longer-term sleep hygiene.

0743 Maternal Experiences of Gender Discrimination Are Associated with Worse Postpartum Sleep

Abstract Introduction Many new mothers experience poor sleep postpartum, which has been found to increase the risk of negative cardiovascular health and mental health outcomes. A few studies have found that experiences of racial/ethnic discrimination are associated with poor maternal sleep, but less is known about the effect of discrimination in other domains. Previous studies have also not accounted for the effect of infant sleep on maternal sleep, which is known to be a major influence in the first year after birth. This study aims to investigate the association between gender discrimination (GD) and postpartum maternal sleep, controlling for infant sleep. Methods The cohort comprised 506 mother-child dyads from the customer base of the Nanit Smart Baby Monitor. At 6–12 months postpartum (Mean±SD: 9.2±1.8), maternal experiences of GD (Everyday Discrimination Scale), perceived stress (Perceived Stress Scale (PSS)), and subjective sleep (Pittsburgh Sleep Quality Index) were assessed. Objective measures of infant sleep were obtained using the Nanit Smart Baby-Monitor. Logistic and linear regressions estimated the associations between maternal experiences of GD and maternal sleep, controlling for PSS, household income, infant age and sex, and objective infant sleep duration and wakings. Results 34.6% of mothers reported experiencing GD. The average PSS score was 15 (± 6.7). Infants had an average sleep duration of 10h (± 1.2) and an average of 3.1 (± 1.4) nighttime sleep wakings. Maternal experiences of GD were associated with shorter sleep duration (OR=1.67, CI=1.07-2.64) and more sleep disturbances (β = 0.77, CI= 0.04-1.49). The PSS was associated with more sleep disturbances (β = 0.11, CI= 0.05-0.16). Objective infant sleep duration was associated with subjective maternal sleep duration (OR=0.57, CI=0.47-0.69). Conclusion Maternal experiences of GD are associated with worse postpartum maternal sleep, suggesting that sleep could serve as a biological pathway relating GD and postpartum health. Future research is needed to investigate the long-term implications of maternal experiences of GD on maternal-fetal health. Support (if any) This research was supported by the Developmental Psychobiology Parent Infant Award and Nanit

0764 End of daylight saving and sleep children 4-24 months

Abstract Introduction Daylight saving time (DST) imposes a twice yearly 1h change in local clock time. Although it may seem a small adjustment, there is increasing awareness of the potential acute and long term effects at the individual and population level. Several studies have shown detrimental effects on sleep patterns, but mostly focusing on adults. Only one study has looked at the effect in infants’ sleep of change from standard time (ST) to DST, reporting negative effects. One study limitation was the reliance on parental reports of infant sleep. In addition, effects of the change from DST to ST are unknown. We hypothesize that the change from DST to ST would lead to earlier rise times, leading to sleep loss in the week following the change. Methods Caregivers of 510 children ages 3-24 mos (M=9.8 mos) tracked their child’s sleep using Nanit baby-monitor. Sleep metrics analyzed were: Nighttime sleep duration (NSD) and midpoint, number of night-wakings and sleep efficiency. Wilcoxon rank sum tests compared the average of each sleep metric for the week preceding the time change (Oct 31st-Nov 4th 2022, Baseline) with sleep metrics for each night of the following week (Nov 7-11 2022, post-DST week). Analyses were repeated stratifying by age group (4-6,7-12 and 13-24 months). Results After the time change, there was no change in NSD or sleep efficiency. There was a significant decrease in the number of night-wakings for infants 3-6 months, with an average of 0.5 fewer wakings per night compared to Baseline (Baseline mean=5 wakings). Midpoint was significantly earlier for all ages by an average of 10min, every day of the post-DST week. Conclusion The return to ST affected infants’ sleep midpoint. Observed effects were minor compared to those reported in previous literature for the ST to DST change, in line with other fields like cardiovascular health. This easier adjustment could be attributed to the fact that during DST there is an increased mismatch between body clock and social clock time, thus infants more readily adjust to a return to ST which minimizes this mismatch. Support (if any) This research was supported by Nanit

0767 INSIGHT Responsive Infant Parenting Intervention and Child Sleep at Age 6 Years

Abstract Introduction The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behaviors and objectively-measured sleep at child age 6 years. Methods Mothers (n=279) were randomized to the RP or control intervention, delivered by nurses at home and clinic visits through child age 2.5 years. Sleep content focused on establishing bedtime routines, age-appropriate bedtimes, and promoting self-soothing at bedtime and after night wakings. At 6 years, children completed wrist actigraphy (Spectrum Plus) for 7 days during the school year. Children with ≥3 valid days were included in analyses (n=162). Mothers (n=173) completed the Children’s Sleep Wake Scale and Children’s Sleep Hygiene Scale. Study group differences for 10 sleep actigraphy variables (M/SD of onset, offset, and midpoint of sleep timing, sleep maintenance efficiency, and total sleep time), as well as survey scores, were examined. Results Children (mean age 6.7 years, 96% non-Hispanic White) slept on average 8.8 hours ± 33 minutes per night, with 40% meeting the minimum recommendation of 9 hours. The mean sleep onset time was 9:14 pm ± 50 minutes. There were no significant study group differences in any actigraphy variables. RP mothers reported higher scores for Total Sleep Quality (4.6 ± 0.5 vs. 4.4 ± 0.6, p=0.03), ‘Going to Bed’ subscale (4.3 ± 0.8 vs. 4.0 ± 0.9, p=0.03), which captures child compliance with bedtime, and ‘Reinitiating Sleep’ subscale (4.6 ± 0.9 vs. 4.2 ± 1.1, p=0.005), which captures the child’s ability to go back to sleep on their own after waking. Total Sleep Hygiene score did not differ between groups. Conclusion The INSIGHT intervention targeting sleep in infancy was associated with improved parental perception of bedtime stalling and self-soothing behaviors at age 6 years. However, this did not translate into differences in sleep duration, timing, or quality measured by actigraphy. Future research should examine strategies to maintain the impacts of the RP intervention on infant sleep into middle childhood. Support (if any) R01DK088244, KL2TR002015

0165 The Relationships between Early Maternal Sleep and Mother-Infant Bonding, and Infant Bedtime Difficulty Later: A Path Analysis

Abstract Introduction Infant sleep is influenced by biopsychosocial factors. However, the influences of early parental sleep quality and parent-infant bonding on infant sleep development are underexplored. This study aimed to examine the relationships between early maternal sleep quality and mother-infant bonding at 8 weeks postpartum, and infant bedtime difficulty at 3 months postpartum. Methods This study is a secondary analysis from the Snuggle Bug/Acurrucadito Study, an observational, longitudinal cohort study investigating the associations between 24-hr sleep-wake patterns, gut microbiome, and weight development among infants. Mothers (n=60, 31.5±5.4y, 66.3% married, 40.8% Hispanic, 41.5% < bachelor’s degree) and their full-term (≥37wk), singleton infants without major complications were recruited from Phoenix, Arizona metropolitan area. At 3 and 8 weeks, and 3 months of infant age, mothers completed the Pittsburgh Sleep Quality Index (PSQI, range:0-21, higher scores indicate worse sleep quality), and reported on infant bedtime difficulty, using a 5-point Likert scale (range:1-5) with higher scores indicating greater bedtime difficulty. Mother-infant bonding was measured by the Postpartum Bonding Questionnaire (PBQ, range:0-125) at 8-week age, with higher scores indicating greater bonding problems. Based on the Transactional Model of Infant Sleep, path analyses were conducted to identify the direct effect of 8-week PSQI scores, and indirect effects of 8-week PBQ total scores and 8-week bedtime difficulty on 3-month bedtime difficulty, using z scores for all variables and the 3-week bedtime difficulty as a covariate. Results At 8 weeks postpartum, the means of PSQI, PBQ, and bedtime difficulty were 5.8±2.6, 5.3±4.7, and 2.4±1.0, respectively. Bedtime difficulty at 3 months was 2.0±1.0. After adjusting for the 3-week bedtime difficulty, the 8-week maternal sleep quality was not directly associated with 8-week (β=.005, 95%CI [-0.31, 0.32]) or 3-month infant bedtime difficulty (β=-0.14, 95%CI [-0.43, 0.14]), whereas 8-week mother-infant bonding significantly mediated the relationship between 8-week maternal sleep quality and 3-month infant bedtime difficulty (β=0.1, 95%CI [0.02, 0.22]). Conclusion This study highlighted that early maternal sleep may disrupt early mother-infant bonding, which, in turn, may increase infant bedtime difficulty later in development. Future research should investigate how best to support healthy family sleep and bonding relationships. Support (if any) NIH/NHLBI R01HL147931

0772 Associations of Sleep Duration and Maternal Postnatal Depression in Infants with Autistic Siblings

Abstract Introduction Evidence suggests sleep differences emerge in the first three years of life for autistic individuals (MacDuffie et al., 2020) and may be a possible endophenotype in unaffected siblings (Naeem et al., 2021). In neurotypical samples, postnatal depression has also emerged as a potential contributor to infant sleep challenges (Dias & Figueiredo, 2021). Questions remain on the associations between infant sleep duration, maternal postnatal depression, and family history of ASD as well as how these variables interact to predict future autistic traits. Methods Participants (N=74) were enrolled in a prospective longitudinal study on early autistic traits and included infants with an autistic sibling (n=33, EL) and with no familial history of ASD (n=41, LL). At 6 months, caregivers completed the Edinburgh Postnatal Depression Scale (EPDS) and a 24-hour retrospective sleep log. At 12 months, clinicians administered a standardized observation of autistic traits (SORF) the includes scores related to deficits in social communication (SCD) and restrictive and repetitive behaviors (RRBs). Results At 6 months, EL infants spent significantly more time asleep during the day than LL infants, (t(45)=2.89, p<.01). There were not significant differences in nighttime sleep duration or EPDS scores between groups. In examining the influence of self-ratings of maternal depression and likelihood status on sleep duration, the model was significant for daytime sleep (F(2, 36)=4.27, p=.02), but not nighttime sleep. Likelihood status, not EPDS score, predicted more hours spent asleep in the daytime. When assessing the role of status and sleep-related variables on future autistic traits, only decreased nighttime sleep duration at 6 months was related to greater RRBs at 12 months (F(3, 10)=15.26, p=.02), regardless of likelihood status. Conclusion The results of this study suggest that EL infants may sleep more in the daytime at 6 months. Reduced nighttime sleep at 6 months possibly signal future autistic traits, regardless of likelihood status. Future research should examine actigraphy data and its relationship to the etiology of ASD in larger samples. Support (if any) Funded by K23-MH120476, R21-DC071252, and T32GM081740.

0791 The Association of Sleep with Developmental and Behavioral Factors in Premature Infants

Abstract Introduction Children with neurodevelopmental conditions often experience sleep problems. Whereas sleep is a predictor of behavioral outcomes in children, there is limited evidence regarding sleep as an indicator of neurodevelopmental concerns. This study examined the prevalence of sleep issues and neurodevelopmental conditions in children with a history of prematurity, as well as the role of sleep as a potential indicator for future developmental and behavioral concerns. Methods Electronic health records of 57 young children (M = 31.9 gestational weeks, range = 23 to 40 weeks; 35.1% girls) presenting to a neonatal follow-up clinic were reviewed. Caregivers completed the Brief Infant Sleep Questionnaire (BISQ-R) between 6-16 corrected months (Mage = 11.6 mos) and then completed the Modified Checklist for Autism in Toddlers (M-CHAT) between 16-26 corrected months (Mage = 20.9 mos). Caregivers also completed the Survey of Wellbeing of Young Children (SWYC; n = 56; Mage = 20.9 mos) and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; n = 32; Mage = 17.4 mos). Results Approximately one-quarter (26.3%) of subjects had a caregiver-perceived child sleep problem at ages 6-16 corrected months. A total of 40.4% of children had clinically significant autism concerns on the M-CHAT and 67.9% had clinically significant concerns on the SWYC. Subsequent caregiver ratings showed that 25.0% of children exhibited challenging behaviors and 34.4% lower social-emotional competency on the BITSEA. Children who demonstrated clinically significant autism risk on the M-CHAT were more likely to have a prior caregiver-identified child sleep problem. Those who later failed the M-CHAT also had increased night waking frequency (2.43 vs 1.82 wakings) earlier in development. Logistic regression indicated that caregiver-identified sleep problems significantly predicted subsequent challenging behaviors on the BITSEA but not later neurodevelopmental concerns on the SWYC or social-emotional competencies on the BITSEA. Conclusion These pilot data suggest that a caregiver-identified child sleep problem at age 6-16 months corrected is linked to more frequent challenging child behaviors in toddlerhood (16-26 corrected months). Caregiver-identified child sleep problems and more night wakings also predicted later neurodevelopmental concerns. Sleep problems in premature infants may thus be an early indication of later behavioral and neurodevelopmental issues. Support (if any)

Longitudinal associations between sleep and weight status in infants and toddlers.

The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.